Glaucoma
Glaucoma is a group of eye conditions that damage the optic nerve, the nerve that carries visual information from the eye to the brain, often in association with elevated intraocular pressure, although optic nerve damage can also occur when the measured pressure is within the statistically normal range. Dr David Robinson has more than 28 years of ophthalmic surgical experience, with a background that includes glaucoma training, research and surgical experience. His assessment helps determine whether elevated eye pressure or other changes are affecting the optic nerve and which treatment approach is appropriate for your eyes.
Unlike many eye conditions that cause noticeable changes in vision, glaucoma can develop without obvious symptoms in its early stages. Vision may appear normal while damage to the optic nerve is progressing, which is why glaucoma is often detected during an eye examination rather than because a patient has noticed a problem.
What Glaucoma Treatment Aims to Achieve
Glaucoma treatment aims to lower intraocular pressure (IOP), meaning the pressure of the fluid inside the eye, to a level that helps protect the optic nerve from further damage. Treatment cannot restore vision that has already been lost because of glaucoma, which is why early diagnosis and ongoing management are important.
Treatment Options for Glaucoma
Treatment is selected according to the type and severity of glaucoma, eye pressure, optic nerve health and other individual factors. Options may include prescription eye drops, laser treatment such as Selective Laser Trabeculoplasty (SLT), and, where necessary, surgical treatment.
Prescription Eye Drops
Prescription eye drops can lower intraocular pressure by reducing the production of fluid inside the eye or increasing its drainage. Depending on the medication prescribed, drops may need to be used once or several times each day and are often part of long-term glaucoma management.
In Plain Terms: A glaucoma eye drop is a medication applied directly to the eye to help lower the pressure inside it. Because glaucoma is usually a long-term condition, regular use and follow-up are important.
Selective Laser Trabeculoplasty (SLT)
Selective Laser Trabeculoplasty (SLT) is a laser treatment that uses low-energy laser applications to the trabecular meshwork (the eye’s natural drainage tissue). The aim is to improve the drainage of fluid from the eye and lower intraocular pressure. SLT is generally performed in an ophthalmology setting using numbing drops and does not require an incision.
In Plain Terms: SLT applies low-energy laser pulses to the eye’s drainage tissue to improve fluid outflow and lower intraocular pressure. The treatment does not involve cutting into the eye.
If eye drops or laser treatment do not provide sufficient pressure control, other treatment options, including glaucoma surgery, may be considered according to the individual patient’s condition and response to treatment.
Who Is an Ideal Candidate for Glaucoma Treatment?
Glaucoma treatment may be considered when assessment identifies:
Established glaucoma requiring pressure-lowering treatment, or ocular hypertension where the assessed risk of developing glaucoma supports treatment
Changes to the optic nerve or visual field consistent with glaucoma
Open-angle glaucoma or another form of glaucoma for which pressure-lowering treatment is appropriate
A need to lower eye pressure further when existing treatment is not providing adequate control
A need for ongoing monitoring to assess eye pressure, visual field and optic nerve health over time
The appropriate treatment depends on the type and severity of glaucoma, the condition of the optic nerve, eye pressure and other individual factors.
Medication Follow-Up
The effectiveness of glaucoma medications is assessed during follow-up appointments, which may include repeat measurements of intraocular pressure and assessment of the optic nerve and visual field. Eye drops do not involve procedural recovery, but they can cause local or systemic adverse effects.
SLT Recovery
Following SLT, some patients experience temporary irritation, light sensitivity or blurred vision. Most people can return to normal activities by the following day, although individual recovery can vary. The effect of SLT is not permanent in every patient and may diminish over time; repeat laser treatment or additional treatment may be considered when appropriate. Follow-up after SLT may include assessment of intraocular pressure and the eye’s response to treatment.
Why an Accurate Assessment Matters
Because glaucoma can progress without noticeable symptoms, regular assessment is important for identifying changes before they become apparent to the patient. Monitoring may include eye-pressure measurement, visual field testing and assessment of the optic nerve over time.
Dr David Robinson brings more than 28 years of ophthalmic surgical experience to the assessment of patients with eye conditions, including glaucoma. His experience includes glaucoma-related clinical work, research, glaucoma surgery, and combined cataract extraction and trabeculectomy (a glaucoma operation that creates an alternative pathway for fluid to leave the eye).
A comprehensive assessment helps determine whether you need treatment or continued monitoring and allows your care to be tailored to your eye condition, eye health and individual needs.
Common Questions Patients Ask
Can glaucoma be cured?
There is currently no cure for glaucoma, but treatment can lower eye pressure and help slow or prevent further damage to the optic nerve. Vision already lost from glaucoma cannot generally be restored, which makes early detection and ongoing treatment important.
Will a patient know if they have glaucoma?
Early glaucoma often causes no noticeable symptoms, and gradual loss of peripheral vision may go unnoticed. This is why glaucoma can be detected during an eye examination even when a patient’s vision appears normal to them.
Is SLT laser treatment painful?
SLT is generally well tolerated. The eye is numbed with drops before treatment, and patients may see flashes of light or experience brief discomfort during the procedure. Temporary irritation or blurred vision can occur afterwards.
Does glaucoma always require surgery?
No. Depending on the type and severity of glaucoma, treatment may involve eye drops, laser treatment, surgery, or a combination of approaches. Surgery may be considered when pressure remains inadequately controlled despite other treatments.
If eye drops are working, why might laser treatment still be considered?
SLT may be considered as an alternative or addition to eye drops in appropriate patients. It can be useful where reducing dependence on daily medication is desirable or where additional pressure reduction is needed. The decision depends on the type of glaucoma, the response to treatment and the individual characteristics of the eye.